Nursing Research and Innovation Journal

Nursing Care for Pediatric Patients Undergoing Transcatheter Pulmonary Valve Replacement

Chutikan Chaiyawech — 2026-08-24

Congenital heart disease (CHD) is a major public health problem commonly found in children. One significant abnormality involves the right ventricular outflow tract (RVOT).Patients with this condition often undergo corrective surgery during infancy or childhood. However,as patients grow, deterioration of the pulmonary valve or the right ventricular outflow conduit used for replacement may occur, resulting in the need for multiple repeat surgeries. Repeated open-heart surgeries carry high risks and require a prolonged recovery period. At present,transcatheter pulmonary valve replacement (TPVR) has become an increasingly popular treatment option for pediatric patients with congenital heart disease involving pulmonary valve abnormalities.In some cases, TPVR can serve as an alternative to open-heart surgery, thereby reducing recovery time, lowering surgical risks, and significantly improving patients’ quality of life. However,TPVR is a complex, costly procedure and is not currently reimbursable under the basic healthcare schemes in Thailand, limiting access to treatment. In addition, TPVR carries potential risks of complications such as infection, vascular obstruction, or bleeding during or after the procedure.Therefore, nurses play an essential role in providing holistic care across all stages of treatment,ranging from physical and psychological preparation and support in accessing healthcare coverage,to close monitoring during the procedure, post-procedural care, and discharge education to ensure treatment effectiveness and patient safety.

This article aims to enhance nurses’ knowledge and understanding in caring for pediatric patients undergoing transcatheter pulmonary valve replacement. It highlights nursing roles in the pre-procedural, intra-procedural, and post-procedural phases, and presents a case study as a practical guide for clinical nursing practice. In the pre-procedural phase, nurses are responsible for preparing patients and families both physically and psychologically, providing clear information about the procedure, expected outcomes, treatment benefits, possible risks, and healthcare rights, and necessary physical preparation before the procedure. During cardiac catheterization, nurses are responsible for preparing the catheterization laboratory, ensuring that all medical equipment, instruments, and devices are available and maintained under sterile conditions, and assisting physicians throughout the procedure. Continuous monitoring of vital signs, electrocardiographic findings, oxygen saturation, and hemodynamic status is essential for early detection and prompt management of complications. Nurses also play an important role in coordinating multidisciplinary care to promote patient safety during the intervention.In the post-procedural phase, nurses must provide close observation for complications, monitor recovery, manage the wound, assess vital signs, and educate patients and families on appropriate self-care after discharge.

This article presents a comprehensive, holistic nursing process through a case study of a pediatric female patient with congenital heart disease (pulmonary atresia with ventricular septal defect) previously treated with a right ventricle to pulmonary artery (RV-PA) conduit.The patient underwent transcatheter pulmonary valve replacement (TPVR) due to moderate conduit stenosis that caused increased fatigue. The nursing care model was systematically applied across all phases of treatment. In the pre-procedural phase, nursing interventions primarily focused on providing detailed information and psychological preparation to alleviate the anxiety of both the patient and her parents. During the procedural phase and post-procedural phase, rigorous standard safety monitoring was implemented, confirming successful valve placement and optimal function without complications. A crucial highlight of this case study is the extension of the nurse’s roles into post-discharge care. The nurse provided essential psychosocial support to address the patient’s anxiety regarding physical activity limitations, specifically transitioning away from high-impact sports. By offering tailored counseling and suggesting safe alternative roles, the nurse facilitated the patient’s psychological adaptation and helped maintain vital peer relationships. Concurrently, the nurse strongly promoted long-term health behaviors, emphasizing regular follow-ups, medication adherence, and meticulous dental hygiene to prevent prosthetic valve endocarditis. Ultimately, these integrated nursing interventions ensured the patient’s safe return to daily life with an enhanced overall quality of life.

Transcatheter pulmonary valve replacement is an innovative and effective treatment for pediatric patients with congenital heart disease involving right ventricular outflow tract dysfunction. By providing a less invasive alternative to repeat open-heart surgery, it can improve functional status, enhance quality of life, and postpone future surgical interventions. However,optimal outcomes depend not only on technical procedural success but also on comprehensive multidisciplinary care. Nurses are indispensable members of this team, providing holistic care through patient preparation, procedural support, vigilant monitoring, education, psychosocial support, and long-term follow-up. Their contributions play a pivotal role in promoting patient safety, reducing complications, facilitating successful recovery, and improving long-term quality of life.

Keywords: Cardiac catheterization, Pediatric nursing, Prosthetic heart valve, Transcatheter pulmonary valve replacement

Perioperative Nursing Care : Elective Caesarean Hysterectomy in Pregnant Women with Placenta Accreta Spectrum

Chadaporn Doneisaun — 2026-08-24

Placenta accreta spectrum (PAS) is a severe obstetric complication and a major cause of postpartum hemorrhage,emergency hysterectomy,and maternal mortality. The pathophysiology of PAS arises from the abnormal invasion of chorionic villi through the decidua basalis into the myometrium,which hinders the normal separation of the placenta from the uterine wall following delivery. The risk of PAS increases significantly among pregnant women with a history of cesarean delivery, uterine curettage,myomectomy,or other procedures that cause intrauterine scarring,particularly with an increasing number of prior cesarean deliveries, which constitutes a major risk factor for the condition in subsequent pregnancies. Consequently, the global incidence of PAS has been increasing steadily, in parallel with the rising rate of cesarean delivery worldwide.

The International Federation of Gynecology and Obstetrics (FIGO) classifies PAS into three grades: placenta accreta, in which the placenta adheres to the uterine wall without invading the myometrium; placenta increta, in which invasion extends into the myometrium; and placenta percreta,in which placental tissue penetrates through the uterine serosa and invades adjacent organs. Further,PAS is subdivided into Grades 3A, 3B, and 3C according to the extent of invasion into the uterine serosa,bladder, or adjacent pelvic structures. Severity grading directly informs treatment planning, multidisciplinary team preparation, resource allocation,and perioperative nursing care planning,making accurate antenatal classification essential to optimizing surgical outcomes.

The currently accepted standard treatment for PAS is planned cesarean hysterectomy, with the placenta left in situ and without attempting placental removal, to minimize massive postpartum hemorrhage and reduce maternal mortality. Nevertheless, this procedure is technically demanding and associated with substantial risks, including massive blood loss, injury to adjacent organs, prolonged operative time, and the need for massive blood transfusion. Therefore, successful management requires meticulous preoperative planning, adequate preparation of blood products and specialized surgical resources, and close collaboration among a multidisciplinary team consisting of obstetricians, anesthesiologists, urologists, radiologists,neonatologists,perioperative nurses,nurse anesthetists,blood bank personnel,and other healthcare professionals.Effective multidisciplinary collaboration is fundamental to improving treatment efficiency and ensuring maternal and neonatal safety.

This academic article aims to synthesize current evidence and present comprehensive perioperative nursing guidelines for pregnant women with PAS undergoing cesarean delivery with hysterectomy. The recommendations are developed using evidence-based practice, international clinical guidelines,and contemporary perioperative nursing knowledge to support systematic patient care across the preoperative, intraoperative,and postoperative periods. This article covers risk assessment,antenatal screening, prenatal diagnosis using ultrasonography and magnetic resonance imaging,disease classification according to the FIGO grading system, multidisciplinary treatment planning, preparation of blood and blood components, preparation of specialized surgical instruments and equipment, operating room preparedness, intraoperative surveillance for potential complications, postoperative nursing care in the post-anesthesia care unit, and safe transfer to the intensive care unit when indicated. The article also emphasizes the importance of standardized communication, accurate patient handover, and effective coordination among multidisciplinary team members to ensure continuity and quality of patient care.

The synthesis of current literature and international clinical practice guidelines demonstrates that successful management of PAS depends not only on obstetricians’ surgical expertise but also on effective multidisciplinary collaboration and coordinated perioperative care throughout the treatment process. Perioperative nurses assume key responsibilities for comprehensive risk assessment, patient preparation, resource management,verification of surgical instruments and medical supplies,blood and blood products, coordination and support of the surgical team, early detection and prevention of perioperative complications, effective communication,effective handover of critical patient information,and continuous postoperative nursing care.

However, implementation of evidence-based perioperative standards, combined with effective interdisciplinary communication, contributes significantly to reducing clinical errors, improving team preparedness, minimizing hemorrhagic complications, enhancing patient safety, and improving maternal and neonatal outcomes.Furthermore, the knowledge synthesized in this article canbe applied to developing standardized perioperative nursing protocols,enhancing perioperative nursing competency, strengthening multidisciplinary team preparedness, and improving healthcare service systems. These findings also support the development of evidence-based clinical practice guidelines and contribute to continuous quality improvement in perioperative nursing practice.

In conclusion,optimal management of pregnant women with PAS requires comprehensive multidisciplinary collaboration and systematic perioperative nursing care throughout the preoperative,intraoperative, and postoperative phases. Accurate risk assessment, meticulous preparation of the multidisciplinary team,blood and blood products,surgical resources,and specialized equipment, together with effective communication and the application of evidence-based practice,are fundamental components of high-quality perioperative care. These strategies can reduce hemorrhagic complications, decrease emergency hysterectomy and maternal mortality, improve maternal and neonatal safety,and enhance the quality of obstetric perioperative nursing care in accordance with international professional standards.The implementation of standardized perioperative nursing guidelines based on current evidence may further promote patient safety, improve the quality of healthcare delivery, and support sustainable development of obstetric nursing practice in tertiary healthcare settings.

Keyword: Caesarean hysterectomy,Perioperative nursing care,Placenta accreta spectrum

Author Contributions:
CD: Conceptualization, Design, Writing and revising the manuscript
PP: Conceptualization, Design, writing, revising, editing the manuscript, Corresponding with the
editor-in-chief
RP: Conceptualization, Design, Analysis, Writing, editing and revising the manuscript

Relationships between Knowledge, Attitude, and Practice Behavior for the Prevention of Coronavirus Disease 2019 (COVID-19) Among Registered Nurses

Prapaporn Sangsuwan — 2026-08-24

Coronavirus disease 2019 (COVID-19) continues to challenge healthcare systems despite the decline in severe cases and deaths since the global pandemic. Although many countries have transitioned COVID-19 to an infectious disease under routine surveillance, new infections continue because of emerging viral variants, waning immunity, and changes in public health measures. Healthcare facilities therefore remain responsible for maintaining effective infection prevention and control strategies to protect healthcare personnel and patients. In Thailand, hospitals continue to implement infection prevention measures in accordance with recommendations from the Ministry of Public Health and the World Health Organization.

Registered nurses play a critical role in infection prevention because they provide continuous, direct patient care and are at increased risk of exposure to infectious diseases. During the COVID-19 pandemic, nurses experienced not only a high risk of infection but also substantial physical and psychological burdens. Infections among healthcare workers also contributed to workforce shortages and increased workloads. These challenges underscore the importance of ensuring that nurses possess adequate knowledge, maintain positive attitudes, and consistently practice appropriate infection prevention behaviors. Understanding the relationships among these factors is essential for developing educational and organizational strategies to strengthen preparedness for current and future emerging infectious diseases.

This descriptive correlational study aimed to examine registered nurses’ knowledge,attitudes, and preventive practice behaviors regarding COVID-19 prevention and to investigate the relationships among these variables. Bloom’s Taxonomy served as the conceptual framework,describing learning as an interaction among the cognitive (knowledge), affective (attitudes),and psychomotor (practice) domains. According to this framework, knowledge provides the basis for understanding health information, attitudes influence acceptance and motivation, and practice reflects the application of knowledge and attitudes to real-life situations. Positive attitudes facilitate the translation of knowledge into appropriate practice.

Participants were recruited using purposive sampling from a tertiary university hospital in Nonthaburi Province, Thailand. Eligible participants were registered nurses currently working in inpatient units, had experience caring for patients with COVID-19, and were willing to participate in the study. The required sample size was calculated using the G*power program with a significance level of .05, a statistical power of .80, and an effect size of .24. The required sample size was 133, with an additional 10% added to account for potential missing data, yielding a total of 146 participants.

Four research instruments were used to collect data: a demographic questionnaire,a knowledge questionnaire on COVID-19 prevention, an attitudes questionnaire, and a preventive practice behaviors questionnaire. Data were collected from June to July 2023 during the circulation of the Omicron variant. Ethical approval was obtained before data collection, and written informed consent was obtained from all participants. Descriptive statistics and Spearman’s rank correlation coefficient were used for data analysis, with statistical significance set at p < .05.

Most participants were female (91.8%), with a mean age of 29 years (SD = 6.96).Nearly all held a bachelor’s degree in nursing (99.3%). Participants had a mean of 6 years of nursing experience (SD = 6.85) and 2 years of experience caring for patients with COVID-19 (SD = 0.79). Approximately half (50.7%) had received four doses of a COVID-19 vaccine,whereas 41.0% had never attended formal training related to COVID-19 prevention and infection control. Social media was the primary source of COVID-19-related information.

Participants demonstrated high levels of knowledge regarding COVID-19 prevention,with 93.8% achieving high knowledge scores (mean = 11.21, SD = 0.99). Likewise, 91.8%reported positive attitudes toward COVID-19 prevention (mean = 35.16, SD = 3.27), and 95.9% demonstrated high levels of preventive practice behaviors (mean = 82.21, SD = 7.36).These findings indicate that registered nurses continued to maintain appropriate infection prevention practices despite the transition from pandemic response to routine disease surveillance.

Attitudes toward COVID-19 prevention were positively associated with preventive practice behaviors (r = .45, p < .01), whereas no significant relationship was found between knowledge and preventive practice behaviors (r = .15, p = .08). These findings suggest that knowledge alone may not be sufficient to ensure consistent preventive practices. Instead, positive attitudes appear to play a more influential role in translating knowledge into practice, consistent with Bloom’s Taxonomy.

The findings highlight the importance of strengthening both knowledge and positive attitudes through continuous professional education, supportive leadership, simulation-based training, e-learning programs, and regular evidence-based clinical updates. Such strategies may enhance nurses’ preparedness for future emerging infectious disease outbreaks and improve adherence to infection prevention measures. Future multicenter and longitudinal studies should investigate additional factors influencing preventive practice behaviors to support the development of more effective infection prevention interventions for nurses.

Keywords: Coronavirus disease 2019, COVID-19, Knowledge, Attitude, Practice behavior,Registered Nurses

Author Contributions:
PS: Conceptualization, Method and design, Data collection, Data analysis and interpretation,Drafting the manuscript, Revising and editing the manuscript, Final approval of the submitted version
PP: Conceptualization, Method and design, Data analysis and interpretation, Drafting the manuscript, Responding to the Editor, Revising and editing the manuscript, Final approval of the submitted version, and Corresponding with the editor in chief
SC: Conceptualization, Method and design, Data analysis and interpretation, Final approval of the submitted version

Effects of a Comprehensive Self-Care Program for Slowing Progression of Diabetic Nephropathy on Self-Care Behavior, Quality of Life, and Clinical Outcomes in Persons with Diabetes and Early Chronic Kidney Disease

Watcharaporn Simsiriwat — 2026-08-24

Diabetes mellitus is a major and growing global health concern that significantly affects health, quality of life, and healthcare systems, particularly as a result of diabetes-related complications and the need for continuous care. Developing an integrated, high-quality care system that facilitates seamless continuity across hospitals and healthcare networks is therefore essential to improving health outcomes among people with diabetes. Individuals with diabetes who are unable to maintain optimal glycemic control are at increased risk of developing both macrovascular and microvascular complications, particularly microvascular complications affecting various organs, including the retinal microvasculature, peripheral microvasculature,and renal microvasculature. Previous studies have demonstrated that for every 1% increase in glycated hemoglobin (HbA1c) above the recommended target, the risk of developing microvascular complications increases by 25%. Diabetic kidney disease, a major microvascular complication, is also a leading cause of chronic kidney disease among people with diabetes of patients requiring kidney replacement therapy for end-stage kidney disease. Therefore, appropriate self-care among people with diabetes can delay the progression of kidney deterioration and improve their quality of life.

This research was a randomized controlled trial comparing outcomes between an intervention group and a control group. The intervention was delivered by an advanced practice nurse (APN). The study aimed to examine the effects of a comprehensive self-care program designed to slow the progression of diabetic kidney disease on patient outcomes. The intervention was developed based on Orem's Self-Care Deficit Nursing Theory, motivational interviewing techniques to facilitate behavioral change, comprehensive diabetes care standards to delay kidney disease progression, and current evidence-based practice. A total of 68 participants with diabetes and chronic kidney disease stages 1–3a were randomly assigned to either the intervention group (n = 34) or the control group (n = 34).

The intervention group participated in a 12-week comprehensive self-care program consisting of two phases. Phase I: the contemplation and decision-making phase focused on preparing participants for behavior change through therapeutic relationship building, comprehensive health assessment, assessment of stage for behavioral change, and evaluation of self-care agency.The researcher employed motivational interviewing strategies, including open-ended questioning,reflective listening, affirmations, and summarizing, to encourage participants to express change talk (self-statement messages). Participants also received supportive-educative nursing interventions, diabetes self-management education, and self-care skills training specifically designed for individuals with diabetic kidney disease. In addition, participants were invited to join a LINE application group that provided 24-hour consultation for health advice and continuous motivational support. During the first week of the program, educational video files entitled "Diabetes Knowledge Package for Patients with Diabetic Kidney Disease" were provided for self-directed learning. Phase II focused on action and maintenance of behavioral change.Participants were followed up every two weeks through the LINE application using video and voice calls. These follow-up sessions were conducted to monitor self-care practices at home,provide counseling, reinforce self-management skills, and maintain motivation for sustained behavioral change. The control group received routine standard care. The total intervention period was 12 weeks. Data were collected using the Self-Care Behavior Questionnaire and the Quality-of-Life Questionnaire. Clinical outcomes included glycated hemoglobin, blood pressure, urinary albumin excretion, and estimated glomerular filtration rate. Data were analyzed using descriptive statistics, the independent t-test, Wilcoxon signed-rank test, and Mann–Whitney U test.

After completion of the 12-week intervention, the intervention group demonstrated significantly higher self-care behavior scores than both baseline and the control group (t = 13.51,p < .001). Quality of life was also significantly higher than at baseline and significantly higher than that of the control group (z = –4.02, p < .001). Estimated glomerular filtration rate was significantly higher than baseline and the control group (t = 3.26, p = .002). Furthermore,glycated hemoglobin was significantly lower than baseline and the control group (t = –6.65,p < .001). Both systolic blood pressure (t = –4.04, p < .001) and diastolic blood pressure (t = –3.32, p < .001) were significantly reduced compared with baseline and the control group.Urinary albumin excretion was also significantly lower than baseline and the control group (t = –2.26, p = .020). The findings indicate that the advanced practice nurse (APN) and diabetes educators should implement this comprehensive self-care program for people with diabetes and early-stage chronic kidney disease to delay the progression of diabetic kidney disease.

Keywords: Clinical outcomes, Comprehensive care, Diabetes mellitus, Early-stage chronic kidney disease, Motivational interviewing

Authors Contributions:
WS: Conceptualization, Method and design, Tool development, Tool validation, Data collection,Data analysis, Writing and revising the manuscript
JT: Conceptualization, Method and design, Supervision, Tool validation, Analysis and interpretation of data, Editing and revising the manuscript
SC: Data analysis, Method and design, Supervision, Tool validation, Analysis and interpretation of data, Editing and revising the manuscript
OJ: Conceptualization, Method and design, Tool validation

Factors Associated with Alcohol Consumption Behavior among Older Adults in Northeastern Thailand

Amphawan Nonthamat — 2026-08-24

Nowaday, Thailand has officially entered a fully aged society, with over 20 percent of the population aged 60 years and older. This demographic transition has significantly affected the health system and social policies, particularly regarding the health and quality of life of older adults. Among the complex and challenging health issues in this population, alcohol consumption stands out as a critical concern. Age-related physiological changes make older adults more vulnerable to the adverse effects of alcohol, resulting in a wide range of health complications-physical,mental, and social. This problem is especially pronounced in Northeastern Thailand,where cultural traditions are closely intertwined with alcohol use. Alcoholic beverages are integral to local rituals, festivals, and community gatherings, making drinking behavior a socially accepted norm.

The present study aimed to determine the prevalence of current alcohol consumption and to examine factors associated with drinking behavior among older adults in Northeastern Thailand, considering multiple dimensions including socioeconomic factors, health status and health behavior, health service accessibility, and social participation. This analytical cross-sectional study utilized secondary data from the 2024 Survey of Older Persons in Thailand conducted by the National Statistical Office. The study sample consisted of 14,629 adults aged 60 years and older residing across Northeastern provinces. Descriptive statistics were used to describe the general characteristics of the participants and to estimate the prevalence of current alcohol consumption. The generalized linear Mixed Model (GLMM) was employed to analyze the association between independent variables and alcohol consumption behavior while accounting for clustering effects at the provincial level. Results were presented as adjusted odds ratios (AOR)with 95% confidence intervals (95% CI).

The findings revealed that 19.73 percent of older adults reported current alcohol drinking. Significant factors associated with drinking behavior included socioeconomic variables such as male gender (AOR=9.21; 95%CI: 8.08–11.51), younger-old adults aged below 69 years (AOR=4.79; 95%CI: 3.53–6.49), current employment status (AOR=2.02; 95%CI:1.79–2.29), and annual income equal to or exceeding 100,000 THB (AOR=1.25; 95%CI:1.10–1.41). Health-related and behavioral factors also showed significant associations, including the absence of chronic diseases (AOR=1.28; 95%CI: 1.14–1.43) and smoking behavior(AOR=7.79; 95%CI: 6.74–9.00). Regarding social participation, membership in local occupational groups (AOR=1.49; 95%CI: 1.24–1.80), participation in volunteer groups(AOR=1.64; 95%CI: 1.37–1.96), and engagement in major village or community events (AOR=1.54; 95%CI: 1.33–1.80) were all positively associated with alcohol consumption.These findings suggest that alcohol drinking among older adults is not merely an individual behavior but rather a social and cultural phenomenon shaped by community norms that encourage alcohol use as part of social engagement. Consequently, abstaining from alcohol can be socially challenging within the Northeastern cultural context.

The study underscores the necessity of developing culturally sensitive health promotion strategies that respect and incorporate local traditions. This includes establishing “healthy community leader” models and empowering village health volunteers to provide culturally appropriate alcohol-related counseling. Moreover, promoting health literacy through local-language communication is essential to correct misconceptions about traditional alcohol consumption, such as the belief that homemade spirits are beneficial to health. Public health policies should therefore focus on mitigating risk factors, creating supportive social environments that promote healthy aging, and encouraging older adults to participate in creative and meaningful social activities that are alcohol-free. A comprehensive and sustainable approach is required to reduce alcohol use among older adults while preserving the cultural identity of Northeastern communities. Such strategies will not only improve health outcomes and quality of life for older adults but also strengthen the cultural and social fabric that supports community well-being in Thailand’s aging society. Therefore, the development of policies and intervention measures to address alcohol consumption among older adults should emphasize integrated actions across multiple levels, including the individual, family, community, and health service system levels.Proactive policies should prioritize systematic risk screening within primary health care services,the provision of brief interventions for older adults at risk, and continuous follow-up through multidisciplinary health care teams. At the same time, capacity building among village health volunteers and older adult caregivers should be strengthened to enhance their skills in motivational communication and in providing culturally appropriate guidance on alcohol reduction. These frontline personnel play a critical role in bridging formal health services and community-based support, particularly in rural and culturally diverse settings. In addition, communities should be encouraged to develop alternative alcohol-free social activities, such as health promotion programs, recreational activities, and volunteer initiatives, to provide meaningful social engagement without reliance on alcohol. Such approaches can gradually reshape social norms related to drinking among older adults and reduce the social pressure to consume alcohol during community gatherings and traditional events. Collectively, these strategies will contribute to a sustainable reduction in alcohol consumption among older adults, while simultaneously promoting active aging, strengthening social support systems, and enhancing overall quality of life in the long term. By adopting an integrated and culturally sensitive policy framework, public health systems can more effectively respond to the complex social and health determinants that influence alcohol use in later life.

Keywords: Alcohol drinking behavior, Northeastern Thailand, Older adults

Author Contributions
AN: Conceptualization, Method and design, Tool development and validation, Data collection,analysis and interpretation, drafting, reviewing, and editing the manuscript, Final approval of the submitted version
NP : Conceptualization, Method and design, Tool development and validation, Analysis and interpretation, drafting, reviewing, and editing the manuscript, and Final approval of the submitted version, Responding to the editor
KS : Tool development and validation, Data interpretation
PS : Tool development and validation, Analysis and interpretation
SG : Tool development and validation, Analysis and interpretation
WP: Provision of feedback on tools development and validation.
JY : Conceptualization, Method and design, Provision of feedback on tools development and validation, Research supervision, Data analysis and interpretation, Drafting, reviewing,and editing the manuscript.

Relationships between Health Literacy, Self-Efficacy, and Re-Falling Preventive Behavior in Older Adults Undergoing Hip Surgery

Saichai Ninpetch — 2026-08-24

Falls in older adults are a significant issue that impacts their quality of life, particularly among those who have experienced a fall resulting in a hip fracture and have undergone hip surgery. Hip fracture is one of the most serious consequences of falls in older adults and is associated with increased disability, functional decline, and healthcare utilization. After undergoing hip surgery, older adults with fractures usually experience loss of mobility, limited ability to perform activities of daily living, increased healthcare utilization, including hospitalization, rehabilitation, continuous follow-up care, and higher healthcare expenditure. The initial 2-week postoperative period is a critical stage due to high limitations on mobility and heightened risk of recurrent falls, which adversely affect physical health, self-confidence, independence, and the ability to perform daily activities safely. During this period, tissue and bone healing remain incomplete, resulting in substantial physical limitations. Older adults often require assistance from caregivers in performing daily activities and adapting to temporary functional limitations. Effective fall prevention requires a multifaceted approach, in which health literacy in fall prevention and self-efficacy in fall prevention are essential factors influencing re-fall preventive behaviors.Health literacy enables older adults to access, understand, evaluate, and appropriately use health information for making decisions related to fall prevention. However, these factors have not been adequately examined in the early postoperative period, when postoperative recovery remains unstable, and the risk of recurrent falls is high. Therefore, investigating these factors during the early recovery phase may contribute to the development of appropriate nursing interventions for older adults after hip surgery.

This descriptive correlational study aimed to examine the relationships between health literacy in fall prevention, self-efficacy in fall prevention, and re-fall preventive behaviors in 76 older adults with hip fractures who underwent hip surgery and were discharged from the hospital during the early recovery phase, when they are particularly vulnerable to recurrent falls.The findings are expected to provide empirical data to develop nursing care plans that promote re-fall preventive behaviors among older adults with hip fractures before hospital discharge.A descriptive correlational research design was used in this study. The participants were selected using purposive sampling based on inclusion criteria, including: (a) aged 60 years and older, (b) having a hip fracture caused by a fall, (c) ability to communicate and understand the Thai language, and (d) no cognitive impairment. Participants were recruited during their scheduled follow-up visit after hospital discharge during the early recovery period. The research instruments consisted of the demographic and health status questionnaire, the Health Literacy in Fall Prevention Questionnaire, the Activities-Specific Balance Confidence (ABC) Scale, and the Fall Preventive Behaviors Questionnaire, developed based on relevant literature. Data were analyzed using descriptive statistics to summarize participant characteristics and key variables, and Spearman’s rank correlation coefficient to examine the relationships among health literacy, self-efficacy, and re-fall preventive behaviors.

The majority of participants were female, with a mean age of 78.63 years. Most had experienced their first hip fracture and had no history of previous falls beyond the incident leading to their current hospitalization. At the two-week postoperative follow-up, many participants continued to experience functional limitations and required assistance with mobility and activities of daily living. The mean score of re-falling preventive behaviors was higher than the midpoint of the scale, indicating a moderate to high level of engagement in preventive practices. This finding suggests that most participants were able to adopt recommended fall prevention measures despite their physical limitations during the early recovery period. Health literacy in fall prevention had a significant positive correlation with self-efficacy in fall prevention (r = .31, p < .05) and re-falling preventive behaviors (r = .34, p < .05), respectively. However, self-efficacy in fall prevention was not significantly correlated with re-falling preventive behaviors (r = .20, p >.05). These findings further underscore the critical role of health literacy in fall prevention in promoting re-falling preventive behaviors among older adults during the recovery phase following hip surgery. The findings indicated that older adults with higher levels of health literacy in fall prevention tended to have greater self-efficacy in fall prevention and were more likely to engage in re-falling preventive behaviors. Nurses and multidisciplinary healthcare professionals should develop intervention programs to enhance health literacy in fall prevention and strengthen re-falling preventive behaviors in older adults during the early postoperative period, thereby reducing
the risk of re-falling.

Keywords : Falls, Health literacy, Hip surgery, Older adults, Re–falling prevention behaviors,Self-efficacy

Author’s contributions:
SN: Conceptualization, Method and design, Instrument validation, Data collection, Data analysis,Manuscript drafting, Revised manuscript
PY: Conceptualization, Method and design, Data interpretation, Revised manuscript,Corresponding with the editor-in-chief
SC: Conceptualization, Method and Design, Data interpretation, Revised manuscript

Factors Predicting Behavioral Intentions to Prevent COVID-19 Infection and Transmission among Postpartum Women

Vorrapun Phadungyotee — 2026-08-24

The coronavirus disease 2019 (COVID-19) pandemic has significantly impacted the physical and mental health of postpartum women. Physiological changes and a weakened immune system during this period increase the risk of respiratory complications if infected. These challenges further affect childcare, breastfeeding, and maternal-infant bonding due to the necessity of social distancing or reduced physical contact. Additionally, these circumstances contribute to increased stress, anxiety, and postpartum depression. While extensive research exists on COVID-19 prevention in the general population and among pregnant women, studies focusing specifically on postpartum women remain limited. In particular, studies examining factors that predict the intention to engage in preventive behaviors against COVID-19 infection and transmission during the postpartum period are scarce. Therefore, investigating the predictive factors influencing postpartum women’s intentions to practice COVID-19 preventive behaviors is essential to provide empirical evidence for the development of appropriate strategies to promote infection-prevention behaviors.

This predictive correlational research aimed to identify factors predicting the intention to practice COVID-19 prevention and control behaviors among postpartum women, using the Theory of Planned Behavior (TPB) as the conceptual framework. A sample of 202 postpartum mothers was selected through convenience sampling. The inclusion criteria required participants who were 18 years of age or older, provided care for their infants, stayed in the same clinic, and were able to read and understand the Thai language. The research instruments consisted of five sets of questionnaires, as follows: 1) a demographic questionnaire, 2) the Attitude Toward the Behavior Scale, comprising a behavioral beliefs questionnaire and an outcome evaluation questionnaire,3) the Subjective Norm Scale, comprising a normative beliefs questionnaire and a motivation to comply questionnaire, 4) the Perceived Behavioral Control Scale, comprising a control beliefs questionnaire and a perceived power questionnaire, and 5) the Behavioral Intention Questionnaire. Data were analyzed using descriptive statistics, including percentages, means,and standard deviations. Spearman’s rank correlation coefficient and multiple regression analysis were used to predict behavioral intentions to prevent COVID-19 infection and transmission
among postpartum women.

The results showed that perceived behavioral control (β = .57, p < .001), subjective norms (β = .17, p = .002), and attitudes toward the behavior (β = .15, p = .009) significantly mutually predicted the intention to practice preventive behaviors, accounting for 63.30% of the variance (R² = .63, F = 113.71, p < .001). Perceived behavioral control emerged as the strongest predictor of postpartum women’s behavioral intention. Therefore, healthcare providers should enhance postpartum women’s ability to adhere to disease prevention measures by ensuring adequate access to protective equipment, providing appropriate guidance, and creating an environment conducive to infection prevention during childcare and breastfeeding. Furthermore, programs should be developed to strengthen social support from significant others, emphasizing family involvement in health education and promoting proper health behaviors. Fostering positive attitudes is also essential to help postpartum women recognize the importance and value of preventing COVID-19 infection and transmission. This includes recommending vaccination for postpartum women and promoting the consumption of foods that help strengthen immune function, maintaining well-ventilated environments, and encouraging hand hygiene or wearing face masks when visiting places with a high risk of respiratory infection. In addition, integrating a mobile application notification platform facilitates the tracking of health-related behaviors, and providing health education may further support the promotion of positive postpartum health outcomes.

Keywords: COVID-19, Intention, Postpartum women, Theory of Planned Behavior,Transmission

Author Contributions:
VP: Conceptualization, Method and design, Tool validation, Data collection and analysis, Writing and revising the manuscript
PP: Conceptualization, Method and design, Data collection and analysis, Writing, revising,editing the manuscript, Corresponding with the editor-in-chief
PD: Conceptualization, Method and design, Data collection and analysis, Revising the manuscript
TC: Writing and revising the manuscript
SL: Conceptualization, Method and design, Data collection, Editing the manuscript
WR: Writing and revising the manuscript

Developing the Empathy Process in Clinical Practice among Nursing Students: A Grounded Theory Study

Siranee Kejkornkaew — 2026-08-24

Empathy is a fundamental professional competency in nursing that underpins holistic,person-centered care, therapeutic nurse–patient relationships, quality nursing practice, and positive patient health outcomes. It comprises cognitive, affective, and behavioral dimensions that must be integrated into professional nursing practice. Although nursing education recognizes empathy as an essential competency alongside clinical competence, most nursing curricula continue to emphasize technical and procedural skills more than emotional development and emotional regulation. Consequently, nursing students frequently encounter challenges in expressing empathy while maintaining professional standards, particularly in complex and emotionally demanding clinical situations. Previous studies have predominantly employed cross-sectional surveys or intervention-based designs to measure empathy levels or evaluate educational programs. Although these studies have confirmed the positive effects of empathy on nursing care and patient outcomes,they provide limited understanding of the developmental process through which nursing students transform emotional awareness and understanding of patients into authentic empathic caring behaviors. In particular, little is known about how empathy develops during clinical practice,where students gain their most meaningful learning experiences. Therefore, this study aimed to develop a substantive theoretical explanation of the process through which nursing students develop empathy during clinical practice using a grounded theory approach.

This qualitative study adopted the grounded theory methodology proposed by Corbin and Strauss. Participants consisted of eleven nursing students (three males and eight females),aged 20–23 years, including four third-year and seven fourth-year students. All participants had completed at least one semester of clinical practice and had experience caring for more than ten patients in various clinical settings, including medical, surgical, oncology, maternity,emergency, and psychiatric units. Participants were recruited through purposive sampling followed by snowball sampling, and data collection continued until theoretical saturation was achieved.Data were collected through semi-structured in-depth interviews, field observations, field notes,and memo writing. Each interview lasted approximately 30–60 minutes, was audio-recorded with participants' consent, and transcribed verbatim. Data collection and analysis were conducted concurrently using the constant comparative method. Analysis followed the coding procedures of Strauss and Corbin, including open coding, axial coding, and selective coding, to construct a substantive theory explaining the process of empathy development. Trustworthiness was established according to Lincoln and Guba's criteria, including credibility, transferability, dependability, and confirmability, through member checking, expert consultation, reflective memoing, and continuous comparative analysis.

The findings revealed that empathy is a dynamic developmental process that gradually evolves through authentic patient care experiences, involving continuous transformations in nursing students' cognitive, affective, and behavioral responses. The resulting theoretical model consisted of five interrelated components.First,causal conditions included patient characteristics and clinical contexts, particularly caring for patients experiencing severe illness or psychosocial problems,which stimulated students' emotional awareness and initial emotional responses. Second, the core phenomenon was identified as a psychological transition from sympathy to empathy. Through sustained patient interactions, reflective thinking, and connecting personal experiences with patients’ lived experiences. Third, interaction strategies included self-emotional regulation and consultation with clinical nurse educators to maintain a balance between empathic engagement and professionalism. Fourth, intervening conditions included clinical experience, diversity of patient conditions, continuity of patient care, and familiarity with patients, all of which influenced the extent to which empathy developed. Finally, consequences included more effective communication with patients, greater commitment to providing holistic and patient-centered care, enhanced professional responsibility.

The findings of this study demonstrated that the transformation from sympathy to empathy represents the core developmental process through which nursing students cultivate professional empathy during clinical practice. This transformation is facilitated by authentic clinical experiences, reflective learning, emotional self-regulation, and supportive supervision from clinical nurse educators, ultimately integrating empathy into students' professional identity and translating empathic understanding into high-quality nursing care. These findings suggest that nursing education programs should intentionally design diverse and longitudinal clinical learning experiences that enable students to establish meaningful and sustained relationships with patients. In addition, clinical nurse educators should foster psychologically safe learning environments, provide ongoing constructive feedback, emotional support, and guided reflection to strengthen students' emotional regulation and facilitate the development of professional empathy.Integrating these educational strategies into nursing curricula may contribute to preparing compassionate, emotionally competent, and professionally responsible nurses capable of delivering high-quality, patient-centered care.

Keywords: Clinical nursing practice, Nursing education, Empathy, Grounded theory, Nursing students

Author Contributions:
SK: Conceptualization, Method and design, Data analysis, Revising and editing the manuscript,Corresponding with the editor-in-chief
KR: Conceptualization, Method and design, Data collection and analysis, Writing, revising, and editing the manuscript

Editorial Note

Supreeda Monkong — 2026-08-24

บทบรรณาธิการ

Medication Adherence to Oral Anticoagulants Among Persons with Atrial Fibrillation : A Systematic Review

Jirawan Vachirasakdadet — 2026-08-24

Medication adherence to oral anticoagulants represents a critical cornerstone in the clinical management of patients with atrial fibrillation, as this medical condition carries an exceptionally high risk of intracardiac thrombus formation due to blood stasis in the fibrillating atria. These formed thrombi may subsequently dislodge and embolize to the cerebral vasculature or other vital peripheral organs, leading directly to ischemic stroke, paresis, or paralysis; in some cases, these severe complications can even be fatal. Preventing such catastrophic adverse events fundamentally necessitates strict, consistent, and continuous adherence to prescribed anticoagulant regimens. However, current evidence indicates that patients still exhibit suboptimal and inconsistent medication adherence, thereby escalating the risk of subsequent complications and increasing the overall economic burden on healthcare systems. Consequently, the explicit objectives of this study were: 1) to review the current situation, analyze, synthesize, and summarize existing research regarding medication adherence to oral anticoagulant therapy among patients with atrial fibrillation, alongside the multifaceted factors influencing such adherence; and 2) to present the synthesized insights toward developing evidence-based nursing guidelines that promote sustainable patient adherence and foster effective engagement in self-management capabilities.

A comprehensive literature review search was rigorously conducted across five prominent electronic databases: PubMed, ScienceDirect, Scopus, Wiley Online Library, and ThaiJO. The database search covered ten years from 2014 to 2024 and utilized specific keywords,such as "anticoagulants," "medication adherence," and "atrial fibrillation." An initial total of 1,609 research articles were identified. Following a multi-stage title and abstract screening process to eliminate duplicates and irrelevant studies, the remaining full-text articles underwent rigorous quality appraisal and methodological evaluation based on the standardized Joanna Briggs Institute (JBI) critical appraisal guidelines. Ultimately, 10 high-quality studies successfully met all predetermined inclusion and exclusion criteria, comprising 1 comprehensive systematic review and 9 robust non-experimental, observational studies.

The findings revealed that the majority of patients exhibited low levels of medication adherence, a phenomenon particularly pronounced among those prescribed warfarin; this was primarily due to the complex requirements for routine international normalized ratio (INR)laboratory monitoring, alongside strict dietary restrictions and potential drug-drug interactions,which collectively disrupted regular medication intake and heightened patient anxiety. In contrast,patients receiving non-vitamin K antagonist oral anticoagulants (NOACs) demonstrated significantly higher and more stable levels of adherence, owing to a streamlined, predictable therapeutic regimen that eliminates the logistical burden of routine blood monitoring and presents fewer dietary and pharmacological restrictions, thereby seamlessly integrating into their daily lives and rendering patients more likely to adhere to their treatment. Furthermore, the factors influencing medication adherence are multifaceted and encompass various dimensions. These include social factors, such as family support, which promotes regular medication intake; and demographic factors, such as age, with findings indicating that older adults tend to exhibit higher adherence rates. Additionally, knowledge and beliefs regarding medication—such as a correct understanding of the dosage regimen, beliefs about the necessity of medication, and perceived barriers to medication adherence—are significantly associated with medication adherence. It was also found that other clinical factors, including comorbidities, type of medication, complexity of the therapeutic regimen, polypharmacy, and duration of treatment, were significantly associated with patient medication adherence.

The findings suggest that adherence to oral anticoagulant therapy is a complex and dynamic behavior influenced by multiple interconnected factors, including patient-related,treatment-related, healthcare provider-related, and healthcare system-related factors. Therefore,promoting consistent medication adherence cannot rely on a single approach. Instead, it requires a systematic assessment of individual barriers and facilitators, taking into account patients’ living contexts and daily circumstances. In addition, individualized educational interventions are needed to enhance patients’ knowledge and understanding of their disease and treatment. Continuous monitoring and evaluation, together with the active involvement of family members and multidisciplinary healthcare teams, are essential to support long-term adherence. Such comprehensive strategies may reduce the risk of thromboembolic events and enhance patient safety. Ultimately, the findings of this review can inform the development of evidence-based nursing guidelines and tailored clinical care pathways for patients with atrial fibrillation. By emphasizing patient education, improving treatment understanding, and promoting active patient engagement in shared decision-making with healthcare providers, these guidelines may support improved long-term medication adherence and reduce the risk of thromboembolic complications.In addition, this approach may contribute to enhanced patient safety and improved quality of life.

Keywords: Anticoagulant, Atrial fibrillation, Medication adherence

Author Contributions:
JV: Conceptualization, Method and design, Data collection and analysis, Writing and revising the manuscript
NU: Conceptualization, Method and Design, Supervision, Data analysis and interpretation, Editing and revising the manuscript, Corresponding with the editor-in-chief

The Personalization of Lifestyle Modification of Stroke Patients: A Scoping Review*

Thanin Rounratna — 2026-08-24

Stroke remains one of the most pressing global health concerns of the twenty-first century, with approximately 13 million new cases reported worldwide each year. In Thailand, the burden of stroke has become increasingly severe, as reflected by rising incidence rates among newly diagnosed patients and a growing rate of hospital readmission, particularly among individuals with comorbid conditions such as hypertension, diabetes mellitus, and dyslipidemia. These trends place considerable strain on the healthcare system and underscore the urgent need for effective secondary prevention strategies. Preventing stroke recurrence is therefore of critical clinical and public health importance, and lifestyle modification—encompassing medication adherence, healthy dietary practices,smoking cessation, and regular physical activity—plays a central role in reducing the risk of recurrence and long-term complications.

In recent years, the concept of lifestyle modification has been increasingly integrated into the management of chronic non- communicable diseases (NCDs) as part of a broader movement toward lifestyle medicine, aimed at promoting effective and sustainable self-management. Rather than applying a uniform approach to all patients, this framework emphasizes individualized lifestyle modification tailored to each patient's unique physical condition, psychosocial circumstances, and cultural context. Core components of this individualized approach include dietary intake, physical activity, sleep quality, stress management, smoking cessation, and social engagement. Despite the growing recognition of this model internationally, its application among stroke populations—particularly within the Thai healthcare context—remains underexplored. This scoping review aimed to examine the existing evidence on individualized lifestyle modification among stroke patients in order to inform the future development of a person-centered lifestyle-promotion model suitable for clinical implementation.

This study was conducted over 12 months, from March 2024 to February 2025. A comprehensive literature search was performed across three major databases—PubMed, Scopus, and ScienceDirect—covering publications from 2014 to 2024. The inclusion criteria were: (1) original articles and review articles (systematic reviews, meta-analysis, narrative reviews) involving stroke patients aged 18 years or older, and (2) original articles with content explicitly addressing health behavior modification. Articles for which the full text could not be accessed were excluded from the review. Study selection was conducted independently by two reviewers to minimize selection bias,with a third reviewer consulted to resolve any discrepancies or disagreements. Data were analyzed using content analysis and descriptive synthesis, supplemented by basic descriptive statistics to characterize the included studies. Methodological quality and reporting rigor were appraised using the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) framework.

Analysis of the 17 studies comprising 5 original articles, 4 systematic reviews, and 8 narrative reviews revealed that dietary control and physical activity were the two components accorded the highest priority in health behavior modification following stroke. With respect to dietary recommendations, ensuring adequate daily caloric intake and adherence to a Mediterranean-style dietary pattern—rich in vegetables, fruits, whole grains, lean protein, and unsaturated fats—were most frequently recommended across the reviewed literature. For patients with comorbidities such as hypertension or diabetes, reduced sodium and sugar intake was consistently advised to support blood pressure and glycemic control. In addition, patients presenting with dysphagia required specialized nutritional care and swallowing assessment to prevent aspiration and the subsequent development of aspiration pneumonia, a common and serious complication in this population. Physical mobility emerged as another critical issue, given that a substantial proportion of stroke survivors experience motor impairment and mobility limitations. Prolonged immobility, particularly among bedridden patients, was found to contribute to muscle atrophy, joint contractures, and pressure injuries. Encouraging patients to engage in activities of daily living, alongside physical exercise appropriately tailored to individual functional capacity,was shown to support motor rehabilitation,prevent secondary complications, and enhance overall quality of life.

In conclusion, this review highlights that dietary control and physical activity constitute the core pillars of post-stroke rehabilitation, contributing meaningfully to reducing complications and preventing stroke recurrence—particularly among working-age patients who must return to meaningful and independent daily functioning. Nevertheless, research on lifestyle medicine within the Thai context remains relatively limited, particularly regarding healthcare infrastructure, digital health technology, and health workforce capacity. As a result, the implementation of lifestyle-based interventions in rural areas and among vulnerable populations remains inconsistent and inequitable.Future research is therefore warranted to explore the lived experiences of Thai stroke patients in modifying health behaviors within authentic social and healthcare system contexts. From a nursing perspective, such research would substantially strengthen nurses' competency in counseling patients on lifestyle modification, particularly by integrating health promotion principles into routine nursing care processes. It would foster stronger interprofessional collaboration across the care continuum.Furthermore, nursing education curricula should place greater emphasis on developing competencies related to self-management support, effective therapeutic communication, and culturally sensitive health education to prepare future nurses to meet the evolving needs of this patient population.

Keywords: Lifestyle modification, Personalization, Stroke

Author Contributions:
TR: Conceptualization, Method and design, Literature review, Article appraisal, Drafting,reviewing, and editing the manuscript, Final approval of the submitted version, Corresponding with editor-in-chief
WJ: Conceptualization, Method and design, Literature review, Article appraisal, Reviewing and editing the manuscript, Final approval of the submitted version

The Personalization of Lifestyle Modification of Acute Coronary Syndrome: A Scoping Review*

Pattaranan Susuthi — 2026-08-24

Acute coronary syndrome (ACS) remains a major public health challenge and a leading cause of mortality worldwide. Cardiovascular diseases account for approximately 17.9 million deaths annually, representing nearly one quarter of global mortality. In Thailand, ACS-related mortality remains substantial, with reported rates of 31.8, 31.0, and 32.62 per 100,000 population in 2020, 2021, and 2022, respectively. ACS is influenced by non-modifiable factors,including age, sex, genetic predisposition, and family history, as well as modifiable behavioral and metabolic risks such as hypertension, diabetes mellitus, dyslipidemia, obesity, smoking,alcohol consumption, physical inactivity, unhealthy dietary patterns, poor sleep quality,psychosocial stress, and limited social support. These modifiable risks highlight the need for sustained health promotion, secondary prevention, and individualized behavioral support.

Lifestyle modification is increasingly recognized as a core component of ACS prevention, treatment, recovery, and secondary prevention. Although pharmacological therapy,coronary revascularization, and clinical monitoring remain essential, long-term cardiovascular outcomes depend substantially on patients’ ability to adopt and maintain healthy behaviors in daily life. Existing evidence often focuses on isolated behaviors, including diet, exercise, smoking cessation, or medication adherence, rather than conceptualizing lifestyle modification as an integrated, person-centered process. Evidence synthesis is also limited regarding how personalized lifestyle modification can be implemented among ACS patients through a holistic framework that integrates individual motivation, family involvement, healthcare counseling, digital health technologies, and environmental support. This scoping review therefore aimed to synthesize current evidence on personalized lifestyle modification among ACS patients within the broader
context of non-communicable disease care.

The objective of this study was to synthesize current evidence on personalized lifestyle modification among patients with acute coronary syndrome, focusing on five domains: diet,physical activity, sleep, social interaction, and stress management. It also examined smoking,alcohol consumption, obesity, body mass index, and factors supporting sustainable behavioral change. Guided by the Personalization of Lifestyle Model of NCD Patients, the review explored relationships among lifestyle behaviors, risk factors, health outcomes, and self-care.

A scoping review methodology was employed in accordance with the PRISMA-ScR framework. Literature searches were conducted in PubMed, Scopus, and ScienceDirect for studies published between 2014 and 2024. Search terms included “Acute Coronary Syndrome,”“Lifestyle Modification,” “Lifestyle Management,” and “Lifestyle Change.” Eligibility criteria included randomized controlled trials (RCTs), systematic reviews and meta-analyses, clinical practice guidelines, rapid reviews, observational studies, and cohort studies involving adult patients with ACS or other coronary artery disease–related conditions that evaluated or addressed lifestyle modification, behavioral change, cardiovascular risk reduction, cardiac rehabilitation,or secondary prevention of recurrent cardiovascular events. Only English-language full-text studies were included. Two independent reviewers screened and assessed the studies, and a third expert reviewer resolved disagreements. Data were analyzed using content analysis and descriptive synthesis.

The initial search identified 10,229 records. After screening titles, abstracts,duplicates, relevance, and methodological quality, 13 studies met the inclusion criteria and were included in the final synthesis. The included studies comprised randomized controlled trials,systematic reviews and meta-analyses, clinical practice guidelines, rapid reviews, observational studies, and cohort studies. Thematic synthesis identified six domains related to lifestyle and behavioral modification in ACS patients: diet, physical activity, smoking and alcohol consumption,sleep, stress management, and social interaction. Diet and physical activity were the most frequently emphasized domains.

Dietary behaviors, physical activity, sleep, stress management, social support,smoking, alcohol use, and obesity emerged as key modifiable factors influencing ACS risk,recovery, and recurrence. High consumption of carbohydrates, saturated fat, and energy-dense foods, combined with inadequate intake of protein, vegetables, fruits, and dietary fiber, was associated with increased cardiovascular risk. In contrast, healthy dietary patterns, particularly the Mediterranean diet, were linked to lower saturated fat intake, greater fiber consumption,improved metabolic profiles, and reduced recurrent cardiovascular events. Regular aerobic exercise, resistance training, and reduced sedentary behavior contributed to improved endothelial function, weight control, reduced inflammation, improved metabolic regulation, and lower recurrence risk. Sleep disturbance, obstructive sleep apnea, insufficient sleep, and poor sleep quality may aggravate hypertension, sympathetic activation, metabolic dysfunction, and recurrent cardiovascular events. Sleep assessment, continuous positive airway pressure therapy, cognitive behavioral therapy for insomnia, and digital sleep monitoring may improve outcomes. Chronic stress, anxiety, depression, and psychological distress were associated with elevated blood pressure, inflammation, and poorer prognosis, whereas mindfulness-based, relaxation, counseling,and psycho-behavioral interventions may reduce distress. Family-centered care, peer support,community engagement, healthcare counseling, smoking cessation, alcohol reduction, and weight control are essential for sustained lifestyle modification.

This demonstrates that personalized lifestyle modification is crucial for reducing ACS risk, preventing recurrence, promoting recovery, and enhancing quality of life. Effective interventions should integrate dietary counseling, structured physical activity, sleep management,stress reduction, smoking cessation, alcohol reduction, weight control, family support, healthcare provider counseling, and digital health technologies. Nurses play a vital role across the ACS care continuum, from prevention and acute treatment to rehabilitation and long-term follow-up.Future research should develop and test culturally relevant, context-specific, technology-supported lifestyle modification programs for ACS patients, particularly in Asian populations and real-world clinical settings.

Keywords: Acute coronary syndrome, Lifestyle modification, Non-communicable diseases,Personalized care, Scoping review

Author contribution:
PW: Conceptualization, Data curation, Investigation, Methodology, Project administration,Writing–original draft, Writing–review and editing
NP: Conceptualization, Data curation, Investigation, Methodology, Project administration,Writing–review and editing, Supervision, Funding acquisition, Corresponding with the editor-in-chief